Provider Demographics
NPI:1154011088
Name:WALTERS, CANDACE ELAINE
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:ELAINE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27555 YNEZ RD STE 110
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4677
Mailing Address - Country:US
Mailing Address - Phone:888-989-9189
Mailing Address - Fax:
Practice Address - Street 1:27555 YNEZ RD STE 110
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4677
Practice Address - Country:US
Practice Address - Phone:888-989-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach